Night terrors are a condition that affects 3 to 6% of children in the United States. The most common age groups affected by night terrors are in kids aged 1 to 9 years. Night terrors are a condition characterized by a sudden awakening from sleep, and a subsequent period of 1 to 30 minutes where the child appears to be in emotional distress but is inconsolable and cannot be fully awoken. The night terror episodes typically resolve on their own, allowing the child to fall back asleep. A child typically does not remember a night terror event in the morning following an episode. For this reason, clinical entry is distinctly different from nightmares.
Night terror episodes are generally thought to be harmless to the child, except in rare instances where the child gets out of bed or walks around engaging in activities that could lead to falls or other injuries. The condition is usually self-limiting, meaning that it will go away on its own. However, night terrors can take years to resolve on their own, usually not until a child is a teenager.
Despite the relative benign clinical course in children, night terror episodes can be very distressing to parents of the child experiencing the terrors. Parents frequently worry about the safety of their child, and they fear for their child's overall well-being given the frequent distressing awakenings. Furthermore, the night terror episodes can be very disturbing to the parent's sleep as they frequently have to awaken to tend to their child during the episodes.
When parents approach a pediatrician about night terror symptoms, typically no treatment is prescribed and the benign nature of the night terrors is explained to the parents. In special situations where treatment is needed, the child can be prescribed benzodiazepine. Another treatment option includes scheduled awakenings where the child is manually awoken by the parent prior to the occurrence of night terrors. This treatment is difficult to carry out by the parents since it is so taxing on their own sleep schedules, resulting in frequent non-compliance.
Sleep comprises two basic states: rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep, which is made up of Stages 1 through 4. During sleep, the body cycles between REM and NREM sleep. Typically, a sleep cycle begins with a period of NREM sleep, followed by a short period of REM sleep. Dreams typically occur during REM sleep. Stage 1 sleep is the first period of light sleep, lasting for approximately 5 to 10 minutes. A person can be awakened easily during Stage 1 sleep. Stage 2 sleep is the transition between Stage 1 sleep and the deep sleep of Stages 3 and 4, typically identified by periods of muscle relaxation, slowing heart rate, and decreased body temperature. Stages 3 and 4 are the deep sleep stages. A person awakened from Stages 3 or 4 may feel disoriented or groggy. Night terrors tend to occur around the time of the transition between REM sleep and NREM sleep. NREM sleep involves the deeper stages of sleep, which includes Stages 3 and 4.